MEDICARE: VALLEY LIFE SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164289088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY LIFE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	6127 W WAGONER RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1150
Country	:	US
Telephone Number	:	480-599-9517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4480 W PEORIA AVE STE 106&107
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-2038
Country	:	US
Telephone Number	:	480-599-9517
Fax Number	:	602-860-6171

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ELTAYEB SHARIF
Credential	:
Telephone Number	:	480-599-9517

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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Directions to “VALLEY LIFE SOLUTIONS LLC ” Practice Location

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